Exposed to tuberculosis--what now?

[BunsenBurner]

<p>A test that detects an antibody against a TB bacterium by definition is not going to differentiate between someone who’s had a TB exposure and developed antibodies agains the bug or a TB carrier who is at risk of developing the disease. The only reliable way is to test for the presence of the bacterium itself, which pretty much means a genetic test detecting the presence of the bug’s genetic material in your blood or tissues. The tests are coming up. It is possible that some of them are alredy available as ASRs (“analyte-specific reagent”), which are genetic tests not yet approved by the FDA. I’m very shocked that the CDC considers anyone with a positive skin test at risk of TB development (nevermind the BCG inoculations!!!) and insists on a 9-month antibiotics course. This is really scary stuff. It means that people who had a positive skin test due to their BCG vaccination and no TB in their system have to take nasty pills, and years from now there will be mutant bacteria causing who knows what kind of diseases!!! The CDC already missed the boat with MRSA and C. Diff and some other ones that are killing thousands in the US alone. Some heads at the CDC need to roll!!!</p>

[my_0.02]

<p>

I’m very shocked that the CDC considers anyone with a positive skin test at risk of TB development and insists on a 9-month antibiotics course.

TB once was the scourge of humanity. A six to nine month course of antibiotics is necessary for effective treatment. </p>

<p>

In 1995, more people in the world died of tuberculosis than in any other year in history.1 The incidence of tuberculosis is increasing, even in the United States. From 1953, when national statistics on tuberculosis were first kept, until 1981, a 5 percent annual decrease in the number of cases of tuberculosis was recorded, and from 1981 until 1985, a 6 to 7 percent annual decrease was reported. However, from 1985 until 1993, there was an almost 10 percent increase in the number of cases of tuberculosis. From 1993 until 1994, a small decrease in the number of cases occurred, perhaps because of enhanced interest in the problem.2 A level of neglect regarding the seriousness of tuberculosis through the 1970s and 1980s worldwide has resulted in the spread of tuberculosis that we now see. Medical schools under-emphasized the public health aspects of tuberculosis control, ministries of health minimized tuberculosis control, and it was disregarded by most funding agencies. The result is that tuberculosis has a higher mortality rate in adults than any other infectious disease worldwide. The tuberculosis epidemic has become a global emergency, and it will not go away on its own. In 1995, for each person who died of the Ebola virus, 12,000 people died of tuberculosis.1 If tuberculosis were a new disease like Ebola, the world would spare little expense to fight it, but tuberculosis has been around for centuries and has become an old, familiar enemy that we have learned to overlook. It is easy to understand why the tuberculosis epidemic is getting worse: For each person who has tuberculosis and is improperly treated, 10 to 15 other people per year may be infected.

</p>

<p>

We know from the past that tuberculosis is controllable if appropriate measures are taken and sufficient interest in doing so exists. These measures include identification of cases, proper treatment regimens, contact identification and follow-up, and proper preventive treatment of those exposed to the disease.

[Editorials</a> - March 15, 1998 - American Academy of Family Physicians](<a href=“http://www.aafp.org/afp/980315ap/edit.html]Editorials”>http://www.aafp.org/afp/980315ap/edit.html)</p>

<p>TB drug resistance does not depend on the presence a drug, so the situation for TB is different than for MRSA.

A final factor contributing to the resurgence of TB is the emergence of multi-drug resistance. Drug resistance in TB occurs as a result of tubercle bacillus mutations. These mutations are not dependent upon the presence of the drug. Exposed to a single effective anti-TB medication, the predominant bacilli, sensitive to that drug, are killed; the few drug resistant mutants, likely to be present if the bacterial population is large, will, multiply freely. Since it is very unlikely that a single bacillus will spontaneously mutate to resistance to more than one drug, giving multiple effective drugs simultaneously will inhibit the multiplication of these resistant mutants. This is why it is absolutely essential to treat TB patients with the recommended four drug regimen of isoniazid, rifampin, pyrazinamide and ethambutol or streptomycin.

From UMDNJ’s [Brief</a> History of TB](<a href=“http://www.umdnj.edu/~ntbcweb/history.htm]Brief”>http://www.umdnj.edu/~ntbcweb/history.htm).</p>

[catbird]

<p>two cents - as the OP I want to assure you that I take TB very, very seriously. The fact that active TB can be inferred from only a skin test surprised me–I assumed that some additional proof of infection was used. Again, thank you for the excellent information and links.</p>

[okgal]

<p>Active TB can not be diagnosed from a PPD; only latent. There is a lot of misinformation in some of these replies and ideology which is not particularly helpful to an individual’s situation. I would suggest calling a public health department well versed in TB and talking to a relatively high up person there; a senior nurse or public health doctor. 2 of the best departments are in San Francisco and Honolulu.
Good luck!</p>

[Princess_Dad]

<p>Would add to ok’s: Univ of Arizona College of Medicine Pulmonary Dept.</p>